Healthcare Provider Details

I. General information

NPI: 1205763174
Provider Name (Legal Business Name): RACHEL JOBE IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 WALNUT DR
GRANBY MO
64844-8234
US

IV. Provider business mailing address

134 WALNUT DR
GRANBY MO
64844-8234
US

V. Phone/Fax

Practice location:
  • Phone: 417-592-0692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-87102
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: